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Indican, Urine

The urine test for indican (also called the Obermeyer test) is an indicator of intestinal dysbiosis and small intestinal bacterial overgrowth (SIBO). Indican is a by-product (chemically an indole) produced when intestinal bacteria react with the amino acid tryptophan. Most of the indoles thus formed are excreted in the feces while a very small amount is absorbed by the intestine, metabolized in the liver, and excreted as indican in the urine.

The amount of indican in the urine increases when inefficient digestion of proteins takes place. When proteins are not adequately assimilated by the body, bacteria metabolize them and break them down in the large intestine with the simultaneous production of indoles, which are absorbed and converted in the liver to indican.

Why test for Indican?

Testing of urine Indican is indicated for the investigation of patients with suspected pathological conditions such as:

  • Small Intestinal Bacterial Overgrowth (SIBO)
  • Intestinal microbial dysbiosis and overgrowth of yeast Candida
  • Disorders in the digestion and absorption of proteins
  • Malabsorption of nutrients and nutritional deficiencies

The modern way of life with intense stress, diets with high consumption of sugar, caffeine, processed foods, excessive food consumption and obesity, stressful and hasty food intake, high consumption of alcohol and smoking, lead to the appearance of the above pathological conditions which in turn can cause the appearance of other pathological conditions such as cancer and autoimmune diseases.

The inability to digest and assimilate proteins can adversely affect glycemic control, hormonal balance, and water balance in the body.

Elevated indican levels may also indicate indigestion and hypochlorhydria (stomach dysfunction). Indican excretion is reduced when the gut is colonized with beneficial bacterial strains and the higher the level of colonization with friendly bacteria, the lower the level of indican in the urine.

Although the test of urine indican is not a specific test for intestinal candidiasis, most patients who show a clinical picture of candidiasis are positive for indican.

Pathological Conditions with increased levels of Indican

Conditions that lead to an increase in urine Indican include:

  • Poor digestion and malabsorption of proteins
  • Hypochlorhydria (gastric acid deficiency, use of antacids or H2 antagonists such as ranitidine [Zantac] or proton pump inhibitors such as omeprazole [Losec])
  • The presence of gases and bloating
  • Diarrhea and constipation
  • Intestinal overgrowth of some "bad" bacteria such as Salmonella, Shigella, Campylobacter, Yersinia, Citrobacter species, Klebsiella pneumoniae, Pseudomonas, some strains of Escherichia coli, Staphyloccocus aureus, Bacteroides, Clostridium, and Candida albicans
  • Intestinal mucosal damage (due to infection, toxic or reactive exposure to various factors, or nutritional deficiency) - Leaky gut syndrome
  • Inflammatory bowel diseases (IBD), such as Crohn's disease and ulcerative colitis
  • Irritable Bowel Syndrome (IBS)
  • Coeliac disease
  • Gastric ulcers
  • Stomach cancer
  • Pancreatic insufficiency (deficiency of enzymes such as trypsin, pepsin, and chymotrypsin)
  • Various malabsorption syndromes
  • Small Intestinal Bacterial Overgrowth (SIBO)
  • Intestinal obstruction
  • Colon diverticulitis
  • Gallstones and obstruction of the bile ducts
  • Intestinal parasitic infections
  • Intestinal fungal infections such as e.g. by Candida
  • Hepatic impairment
  • The abuse of antibiotics
  • The various nutritional deficiencies
  • Blue diaper syndrome and Hartnup disease (hereditary metabolic miseases)
  • Scleroderma
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